MSK 2
Terms
undefined, object
copy deck
- What is eczema skin like?
- Vesicles due to intercellular swelling. The vesicles are filled with fluid that leaked through the the cells.
- What is the acute phase eczema?
-
*oozing and crusting due to swelling b/w cells
*bulla on skin
*basal cell inflamm. on histo - What is the chronic phase of eczema?
- Lichenification
- What is the atopy triad with which eczema is associated?
- Eczema, asthma, hayfever
- What Ig and what immune cell is elevated in the eczema pt's serum?
- IgE and eosinophils
- What MUST you have to be dx with eczema?
- pruritis (itchy skin)
- what parts of the skin does eczema involve?
- skin creases--elbow folds, back of the knees, ankles, neck
- What are the dxstic guidelines of eczema?
-
*involvement with creases
*hx of having the atopic triad (IgE hyperactivity)
*hx of general dry skin
*Flexural eczema (eczema on cheek/forehead/outer limbs in kids under 4)
*onset under age 2 - What is a bad se of topical steroids?
- Thins the epidermis. Therefore don't use for more than 2-3 weeks at a time.
- Where do you want to avoid steroid crm use and why?
- Places where systemic absorption of the drug is increased. Avoid this because you can get a cushingoid like state due to high systemic steroids.
- Class I steroids are the most potent Class VI steroids are the least potent
- TRUE
- Class I drug?
- Temovate (Clobetasol)
- Class II drugs?
- Lidex and Topocort
- Class IV drug?
- Elocon
- Class VI drug?
- Desowen
- What do you tell a pt to stop the itching fast?
-
*Cool water/milk compresses
*ASA--b/c itch and pain ride on the same nerve - Small pox vaccines can be given to eczema pts?
- NO! NO! no no no no no no!
- What is the mechanism of GI toxicity induced by NSAIDs and how prevalent is this se?
-
Prostaglandin inhibition. PGs are necessary for mucus production that protects the GI tract.
20% - MOA of action of NSAIDs vs. DMARDs?
-
*NSAIDS affect sxs only by inhibiting PG
*DMARDS can change the course of dz by stabilizing golgi lysosomes. - How are APAP and ASA diff?
- APAP doesn't have anti-inflammatory activity.
- What does Enbrel do?
- TNF R inhibitor and therefore blocks inflamm. response.
- What does minocycline do?
- blocks metalloproteinase and therefore blocks CT breakdown.
- Which drug is used to treat acute gouty arthritis and why?
- Indomethacin because it inhibits uric acid formaxn.
- Acute Urticaria resolves completely within how many weeks?
- six. Anything greater is considered chronic urticaria.
- Describe the urticaria lesion
- Annular/papular with erythematous border.
- What are causes of urticaria?
-
*IgE mediated (allergies)
*Compliment
*Mast Cell degranulation - What causes compliment mediated urticaria?
- Serum sickness, angiodema (subcutaneous edema)
- What % of urticaria is idiopathic?
- more than 75%
- How do hives arise?
- Inciting agent causes mast cell degranulation--> histamine causes capillary permeability--> protein and fluid extravasate into interstitum--> swelling
- What is the defn of dermographism?
- Hypersensitivity to touch. Anything that lightly strokes the skin can cause urticaria. Ex: running a pencil across your arm.
- What is solar urticaria?
- Urtic. in response to UVA and UVA light.
- What is cholinergic urticaria?
-
Urtic. caused by cholines in response to:
exercise
emotional stress
increased environmental temperature - Cold urticaria is?
- urtic. due to cold!
- Something that looks like urticaria but is NOT is found on muscle bx to be urticarial vasculitis. What is this?
- Urticarial Vasculitis: pts tend to be sicker and the lesions last longer than 24-48h.
- What is tx for urticaria?
-
*HI and H2 blockers (antihistamines)
*steroids (short term, last resort)
*avoid the inciting agent - What is a drug eruption?
- Allergic rxn to Rxs
- What are three forms of drug eruptions?
-
1) exanthem
2) urticarial drug rxn
3) hypersensitivity syndrome - What drug is the most common cause of drug exanthems?
- Sulfamethoxazole/trimethoprim
- What is the pattern of the lesion seen in drug exanthems?
- morbilliform with erythema and small papules.
- Pts who have hypersensitivity syndrome to drugs are most sensitive to:
- anti-convulsants, sulfonamides, and allopurinol
- Hypersensitivity syndrome sxs are:
-
*elevated LFTs
*scaling, vesicles, bullae, and sloughing of the skin
*fever
*lympadenopathy - What are the viral exanthems and in what population are they seen?
- Measeles, rubella, erythema infectiosum. Most seen in peds.
- Viral exanthem rashes start where and spread where?
- Start on the face and spread to the trunk and extremities over the course of a few days.
- Hypersensitivity syndrome:
-
Eyrthema Multiforme
Stevens-Johnson Synd
Toxic Epidermal Necrolysis
Erythema Nodosum - Erythema multiforme is most often due to
-
HSV.
Less common is URI - What do EM lesions look like?
- erythematous plaques and papules with targetoid lesion. they are symmetrical
- EM lesions are mostly seen where in the body?
- Mucus membranes, palms, and soles.
- Patient presents with fever and flu like sxs. They have targetoid lesions all over their body and most signficantly, on their lips. What is likely dx>
- SJS
- TEN is also a derm emergency. What is it?
- Diffuse necrosis of the skin that leads to sloughing and loss of skin. Urgently move to burn unit.
- SJS and TEN often overlap as diagnoses. When does SJS become classified as TEN?
- when there is over 30% of skin sloughing
-
When should you NOT use steroids in treating SJS?
When do you use steroids in treating TEN? -
If the SJS is advanced, DO NOT use steroids. Steroids are helpful early in the dz but harmful later.
NEVER use steroids to tx TEN. - What is the most common cause of SJS and TEN?
- drugs! SMX/TMP
- What is erythema nodosum? What population is it most commonly seen?
-
Nodules deep in the subcuticular tissue.
Young women. - Where in the body is E. Nodosum most seen?
- Anterior Tibia
- What is vasculitis? How is it manifested in the skin?
-
Inflamm. and necrosis of blood vessels.
It is seen as palpable purpura in the skin. - What is the etiology of vasculitis?
- Infection, PCN, sulfa, CT dzes such SLE, IBD, hepatitis, cancer
- What is the ddx of vasculitis? How does it present?
- Schamberg Dz. See little purpura on the lower legs only. Is probably a a capillaritis.
- What is higher frequency and therefore more damaging, UVA or UVB?
- UVB
- Which wavelength is seen in tanning salons?
- UVA
- Which wavelength causes burns that are dose dependent?
- UVB
- If you get an immediate sunburn but it's so mild you don't even know it's there, what wavelength caused it?
- UVA
- A red haired, fair skin, light eyed girl is what skin type?
- Type I
- Which kind of tanning is "better" for your skin and why?
- UVB tanning is better, because it not only darkens existent melanin but it causes new melanin to form (whichis protective). Therefore, tanning salons which only have UVA are less safe.
- Where in the body does vitiligo usu occur?
-
FACE: peri-oral, peri-ocular, and on the lips.
BODY: knees, groin, armpits, butt. - what is Polymorphic light eruption?
- skin rash in response to the sun
- what has a faster onset, phototox or photoallergy?
- phototox
- Elderly patient comes in with large tense bulla in his lip that ruptured. He reports that this happened last month, too, but it spontaneously healed. Likely dx?
- Bullous Pemphigoid
- What is the Asbo Hanson sign?
- Lateral spread of the bullous when you press on it
- What ab is involved with dermatitis herpetiformis?
- IgA
- What GI condition is associated with D. Herpetiformis?
- Celiac Sprue (gluten insensitivity)
- What is a nevus?
- a mole. not malignant till they get in the hundreds.
- What shapes are junctional, intradermal, and compound nevi?
- flat, raised, dome-shaped.
- Describe a recurrent nevus and why it should be excised?
- Irregular border. It may precede melanoma.
- What is the main cause of melanoma?
- UV light
- Where do people of color get melanoma?
- Sole of feet
- Name the clinical features of melanoma
- assymmetrical, irregular border, varied color, bigger than 6 mm, elevated
- Seborrheic keratosis lesions are benign. What do they look like?
- Tan/brown scaly plaque
- What is the most common non melanoma skin cancer?
- Basal Cell Carcinoma
- It is a risk for what people?
- fair skinned, sun exposed
-
What re the three basic kinds of BCC?
Which one is most difficult to tx? -
1) nodular
2) superficial
3) infiltrarting/morphea--hardest to tx - Nodular BCC is the most common. What are the characteristics?
- Pearly, waxy looking plaques. They may have telangectasias
- What superficial nerve is at risk during surgery to remove a nodule on the periorbital part of the face?
- temporal N
- How does the superficial kind of BCC differ than the other two?
- It does not come and go like the others. Instead, it gets bigger over time.
- What does the infiltrating/morphea BCC type look like?
- White/yellow scar like plaque
- What does a morphea lesion look like?
- starts out violaceous, then becomes white in the middle with a red/pink surround.
- What In Basal Cell Nevus syndrome, every tx can be used except?
- radiation. it makes it worse.
- Actinic keratosis is a scaly sun spot. It's a marker for what kind of skin cancer?
- Squamous cell carcinoma
- What does SCC in situ mean?
- It is the intermediate stage b/w actinic keratosis and full blown SCC.
- Pt presents with rythematous papules that are rapidly growing and are on the lower lip and ears--places that are sun exposed. Dx?
- SCC
- What benign lesion mimics BCC?
- Sebaceous Hyperplasia
- A 13 year old girl presents with a raised, yellow plaque on her scalp. Her mother states that when she was a newborn, this area had no hair. Dx?
- Nevus Sebaceous
- What benign lesions are found near the eyelid?
- Syringoma and hydrocystoma
- What benign skin lesion is associated with tuberous sclerosis?
- angiofibroma
- What benign cyst is located at the nail fold?
- mucous cyst
- What is an acrochordon?
- a skin tag
- Rickettsia is a parasite that causes?
- Rocky Mtn Spotted Fever
- Describe the shape and growth requirements of Rickettsia
- Coccobaccilli that are obligate intracellular parasites
- What Abx is used to empirically tx RMSF?
- Doxycycline
- Rickettsia is divided into these two groups:
-
1) spotted fever
2) typhus - Are humans considered reservoirs for Rickettsia?
- NO! We are only incidental hosts!
- What time during the year would you see Rickettsia?
- Spring and summer
- What causes the rash in Rickettsia?
- The parasite proliferates in the endothelial cells of bvs--> vasculitis--> blocks b.f. to skin--> rash and necrosis of skin
- A pt presents with rash, fever, HA, and a hx of hiking or camping where ticks occur. DDx?
- Rickettsia!
- What state has the most spotted fever?
- N. Carolina
- In the Spotted Fever subtype, there are 3 subtypes. They are:
-
1) RMSF
2) Boutonnouse Fever
3) Rickettsial Pox - RMSF is caused by a tick that carries what parasite?
- Rickettsia rickettsii
- When this parasite enters your skin, it goes to your_________and then proliferates in your__________
-
lymphatic and blood vessels
endothelial cells - The edema, hemorrhage, and hypovolemia seen in Rickettsiosis is due to:
- vascular permeability caused by endothelial injury (caused by rickettsii proliferating at cost of endothelial cell)
- What kidney manifestation is seen in RMSF due to the hypovolemia?
- Pre-renal azotemia
- What other clinical manifestations of RMSF do you see?
-
fever, myalgia, HA, malaise, rash (due to vasculitis), meningoencephalitis, lung problems.
**most impt to think about when making the dx is: RASH and TRAVEL HX to tick area/N. Carolina** - Lab shows normal WBC but low__________
- bone marrow cells: low plts and RBCs
- Mortality of RMSF is LOW if it is txed early. What do you treat with?
- Tetracycline, Doxycycline, Chloramphenicol.
- What is the characterisitc skin lesion of Boutonnouse fever?
- Tarche Noir=black area of necrosis where the tick bit
- T or F: leaving Rickettsialpox untreated is FATAL
- F. It resolves untreated in 2-3 weeks...but tx with doxycycline anyway until you are sure that you are correct in your dx!
- How do you get Rickettsial pox?
- House mice!
- Q Fever is caused by a dessication resistant parasite that is acquired by humans when they
- touch secretions of farm animals--milk, pee, poop, birth fluids
- So Q Fever is an occupational dz of:
- Farmers and Veterinarians
- How is Q Fever different than the other two Spotted Fever subtypes?
- No rash!
- Q Fever has a heart complication. What is it?
- Endocarditis. It's a common cause of aseptic endocarditis...
- Rickettsia prowazekii causes ________
- Typhus
- Typhus is associated with what kinds of living conditions?
- War, famine, overcrowding
- What is the typhus vector? the reservoir?
-
body lice=vector.
flying squirrel=reservoir - What is the rash distribution in typhus?
- centrifugal--it moves from center to periphery
- What is the tx for typhus?
- doxycycline
- The RMSF rash is centr______while the typhus rash is centr_______
- centripetal, centrifugal
- What organism causes over 90% of elephantiasis (aka filariasis)?
- Wucheria Bancrofti
- What kind of living condns do you see filariasis?
- uncontrolled mosquito breeding in overcrowded cities
- The microfilariae (the egg) of the parasite lives in travels to through the ________ and arrive at the _________ where they mature into adults and live permanently
- lymphatic vessels, lymph node
- There are 2 stages of filariasis. In the asxtic stage, what is happening with the lymph endothelium and in the immune syst?
- The lymph endothel. is proliferating and the immune system is downregulated
- In the sxtic stage, what is happening in the lymph nodes?
- Inflammation in the nodes which leads to fibrosis of the nodes
- Do newcomers to Filariasis endemic areas get ill faster or slower than the native popul?
- faster!
- What is the diff b/w lymphangitis and lymphadenitis?
-
lymphangitis=INFECTIOUS inflammation of lymph
lymphadenitis=NON-INFECTIOUS inflamm of lymph - In filaria, retrograde lymphadenitis is seen. It's the response to the dying adult worm. What is the pattern of spread?
- Moves from out toward center of the body
- What are other sxs of filariasis besides retrograde lymphadenitis?
-
*fever
*hydrocele in males
*chyluria (milky white urine)
*elephantiasis (big, hard tissue due to edema and destruction of lymph tissue) - A pt comes in with mily white urine, big lymph nodes that spread from her hands toward her armpits, and she's had a fever. To make the definitive dx of filariasis, when do you want to draw her blood?
- late at night
- What is the drug used to tx both individuals and the community for filariasis?
- DEC
- Dracunculiasis will most likely be eradicated in the near future. What is it?
- A larva of a parasite penetrates the GI tract.
- From the GI tract where does it mature and then migrate?
- matures in the CT or in the abdomen and then migrates to the skin
- When is the larvae discharged from the skin?
- whenever the skin gets wet
- how do you remove the dracuncula worm?
- you have to roll it up with a stick, very carefully, day after day, until it's lifted. that's so weird.
- trichinosis is a parastie in what animal? we eat it when we eat this meat raw or undercooked....
- pigs! (men are pigs)
- where in the human does the parasite go to encyst and calcify?
- muscle
-
pt presents with myositis, edema around the eyes, and hemorraghes in the retina and in the finger nails. Dx?
How would you treat her? -
trichinella
nothing very useful in the way of tx--steroids and albendazole may help but mostly supportive? - What would you tell her to avoid? What would you tell the farmers who raise the pigs?
-
Avoid bears--they carry trichinella too
Grain feed swine - In cutaneous larval migrans, the larva creeps around the skin causing itchiness. Is it necessary to remove the larva before it causes damage?
- No. it dies on its own and causes no complications besides pruritis.
- What is cysticercosis? What popul is it most commonly seen in ?
- Pork tapeworm, seen most in mexican/L. American immigrants
- What is the neural complication of cysticercosis? What is seen on MRI of the brain?
- seizures! multiple cysts!
- When the larvae of cysticercosis encyst in the muscle, what immune cell tells you it's there? What happens if it encysts in the eye?
-
eosinophils
causes vision loss - What is the chemical name of the histamine ring?
- Imidazole
- Mast cells store histamine. They turn blue when stained with a special dye...this is called?
- Metachromasia
- What is the entity in the mast cell that is responsible for metachromasia?
- the protegoglycan interacts with the basic dye giving a color shift.
- Why is histamine slowly synthesized and slowly metabloized? (slow turnover)?
- it is tightly bound to vesicles
- Where else is histamine found in the body?
- GI mucosa and brain. It has a faster turnover in these two locations.
- What two cells mediate the synthesis of nascent histamine?
- macrophages and plts
- what is the precursor of histamine? What is the enzyme that converts it?
-
L-histidine
Histidine decarboxylase -
What is the action of Histidine decarboxylase on L-histidine?
Is it's level high or low in the GI mucosa? -
Histidine decarboxylase removes CO2 from L-Histidine
high levels of this E in the GI mucosa - What are the two pathways by which histamine is metabolized? Which one is dominant?
- Oxidation and Methylation (dominant)
- What is the E in the oxidation pathway?
- Diamine oxidase
- What is the E in the methylation pathway? What is the necessary Co-factor it needs?
-
Histamine-N-methyl transferase
SAM (S-adenosyl-L-methionine) -
What does this E do to the histamine molecule with SAM?
What is the name of the product? -
It removes the a methyl group from SAM and puts it on the histamine.
N-Methylhistamine -
What E acts on N-methylhistamine?
What is the product and how is it excreted? -
Monoamine oxidase (MAO)
MIAA. It's excreted in the urine. -
What is a marker of histamine amnts in the tissue?
What is a marker of histamine release? -
Marker in the tissue: Histadine Decarboxylase
Marker of release: amount of MIAA in the urine - There are two Rs of Histamine that we must know: H1 and H2. Which one is fast vasodilation and which one is slow?
-
Hi=rapid vasodilation
H2=slow vasodilation - Which R is found in the heart? What is the effect of stimulating these Rs?
- H2. Increase in HR, SV, and CO
- Which R is found in the bronchiolar smooth muscle and what is the effect of their stimulation?
- HI. Constriction--> wheezing
- Which R is found in the gastric mucosa? What is the effect of stim?
- H2. Increased acid and pepsin secretion.
- Which R is found in the rest of the intestinal tract smooth muscle? Effect of stim?
- H1. Smooth muscle contraction.
- Both H1 and H2 Rs are found in the skin. They cause the triple response which is what?
-
1) small red spots at the site of injection
2) flare
3) wheal - What causes the wheal and flare rxn?
-
The flush is due to stimulation of the local afferent nerves which fires the efferent nerves-->vasodilation.
The wheal is edema due to fluid leakage from the permeable capillaries. - H1 R raise Ca levels how?
- H1 Rs are linked to PLC which leads to IP3 and DAG formaxn. IP3 causes an increase in Ca levels.
- H2 Rs effects occur via production of what G protein product?
- cAMP
- Histamine causes contraction of smooth muscle in the stomach but not in the heart. Why?
- H1 Rs in the intestinal smooth muscle are physiologically active while H2 Rs in the heart are not.
- Histamine mediates arousal in the brain. In the brain, histamine is made in the?
- tuberomammillary bodies.
- Hist. release from the mast cells is dependent on which cation?
- Ca
- What Ig is associated with histamine release? Where does it bind to the Mast cell?
- IgE. Fc R.
- What are the diff b/w 1st and 2nd generation H1 antagonists?
- 2nd gen. don't cross the BBB, they aren't anti-cholinergic so the s.e.s are less, and they have a longer duration of action.
- What are the generic names of 5 1st generation H1 antagonists?
-
-diphenhydramine
-PYRIBENZAMINE
-chlorphenyramine
-CYCLIZINE
-promethazine - What is the effect of H2 antagonists?
- lower HR, lower CO, and lower acid secrexn.
- What liver E does cimetidine block?
- CYP 450
-
What is the only containdication of cimetidine?
What Rxs have big interactions with cimetidine? -
gastric cancer
Theophylline, phenytoin, warfarin - What is the MOA of cromolyn? Is it considered an anti-histamine?
- It stablizes the mast cell membrane and prevents release of histamine. It IS NOT an anti-histamine because it doesn't relax smooth muscle.
- Cromolyn can be used in young asthma pts, including the case of status asthmatics?
- it CAN be used in asthma pts, but HAS NO VALUE IN STATUS ASTHMATICUS!
- What is another indication of cromolyn?
- It can be used for allergic rhinitis when used as a spray!
- Tilade is...and is used for....
- a new Rx that is an anti-histamine release drug...used for asthma
- What do psoriasis lesions look like? Where in the body are they most common?
- Well demarcated, scaly erythematous plaques. They are most common on the elbows, scalp, and knees.
- What is the major systemic manifestation of psoriasis?
- Arthritis--sausage fingers
- What is Auspits sign?
- a dark spot due to Fe from spot bleeding after scratching off a psoriasis plaque
- What is the Koebner phenomenon?
- Lesions that appear at sites of injury
- In Lichen planus, you can see whitish lines in the plaque. These are called
- Wickim's striae
- Where in the body do find Lichen Planus lesions the most?
-
trunk
mucus membranes (mouth/lips)
pre-tibia - A teenage female presents with one big red scale (fawn-colored) and some satellite scales that surround it. She says this happened last month but resolved on its own. DDx?
-
Pityriasis Rosea.
Secondary Syphilis. - Spaghetti and meatballs is the description that is seen on KOH test for this fungal infection. Is it superficial or deep?
- Tinea Versicolor. Superficial.
- Syphillis is associated with what tick dz?
- Lyme Dx. Lyme Dz is syphilllis reborn(??)
- "micacious" and "hyperkeratotic" are buzz words for lesions in what dz?
- psoriasis
- pustules in psoriasis form due to infiltration of what immune cell?
- neutrophils (PMNs)
- What is the oil sign?
- yellowing of the finger nail due to deposition of serum
- Psoriatic arthritis affects these joints:
- IP joins in the hands
- Why do psoriatic plaques bleed so easily when picked?
- The dermal papillae in psoriasis is thickened and extends all the way into the epidermis. When the scale is picked, it exposes the dermis where the bvs are.
- In which dermatitis do patients not scratch because there is no itch relief?
- Lichen Planus
- How come fungal infections have rings that get bigger on the skin?
- it consumes keratin and has to move out in order to "eat live skin"
- How do you differentiate b/w syphillis rash and P.R. rash?
- In syphillis, the rash will go to the palms of hands and feet. Also, see chancres on the genitalia and in oral mucosa
- What food products exacerbate Rheumatoid arthritis?
-
Wheat, citrus, dairy, and nuts.
Also, coffee -
What is desired range of Vit D?
Vit D deficiency is considered? -
Above 30 ng/ml
Belove 20 - What is the relationship between Vit D and Ca?
- Vit D facilitates Ca absorption in the gut
-
Vit D Cascade:
Skin-->liver-->kidney--> intestine and bone - D3-->25(OH)D-->1,25(OH)D--> gut and bones
- What is the affect of anti-oxidants on RA?
- Anti-oxidants stop oxidative damage and therefore may be protective agains the damage in RA
- Why would low fat diets aggravate RA?
- Low fat diets are low in Vit E and Vit A, two anti-oxidants that would protect against joint damage.
- The desaturase E converts omega-6 and omega-3 between each other. What factors cause the E to make more omega-6?
-
high etoh
stress
diabetes
high 6/3 ratio - Supplements to reduce pain and inflamm in RA?
-
Vit D, E, C
Selenium
Calcium
omega 3 oils
olive oil
EPA - What would daily caloric and protein requirements be for pts who need to gain weight due to RA?
-
35 kcal/kg of actual weight
1.5-2.0g/kg of ideal weight - Why does prednisone aggravate osteoperosis?
- It causes increased Ca excrexn and decreased Ca absorpxn
- what is the action of omega-3 on bone resorpxn and inflamm?
- suppresses osteoclastic activity and pro-inflamm cytokines
- Purposes of bone?
-
biomechanical
metabolism
hematopoiesis - What's the diff b/w compact bone and spongy/cancellous bone?
-
Compact bone=structure
Cancellous bone=hematopoiesis - Bone is comprised of three things:
-
1) collagen matrix
2) mineral salts
3) cells - Collagen matrix is composed of:
-
1) type I collagen
2) proteoglycans - Mineral of bone is called hypoxyapetite. It is composed of two elements:
-
1) Ca
2) phosphate - The cells of bone are:
- osteoclasts, osteoblasts, and osteocytes
- What lines the external surface of bone? what are its two layers called?
-
Periosteum
outer layer=fibrous
inner layer=osteoprogenitor cells - What lines the internal surface of bone?
- Endosteum
- What are the two types of joints and which one allows for movement?
-
1) Diarthroses=allows for free movement
2) Synarthroses=no free movement - Which two factors are cause an increase and Ca absorpxn and breakdown of bone?
- PTH and Vit D
- PTH responds to a _____in Ca levels. It
- drop
- What is the defn of simple arthritis?
- Joint complaints for more than 6 weeks
- What characterizes INFLAMMATORY arthritis?
- pain, swelling, warmth, erythema, and synovial thickening.
- what are sxs of RA?
- morning stiffness, multiple joints involved, symmetrical joint involvement, subcutaneous nodules.
- what are systemic sxs of RA?
- vasculitis and ILD
- in RA, what will the CBC show?
-
high plt count (thrombocytosis)
normocytic, normochromic anemia - ESR is high/normal in RA?
- high!
- Why does bone form cysts when the cartilage erodes?
- to increase the surface area so that pressure can be spread out
- Which immune cell recognizes self-peptide as foreign and what cell does it present to?
- Macrophage. Presents to a T Cell.
- HLA gene complex is on Chromosome #?
- 6
- What is Rheumatoid Factor? Which immune cell makes it? What does it do?
-
RF is an anti-IgG immunoglobulin made by plasma cells. It forms complexes with IgG and then activates complement.
Complement causes the tissue inflamm. and destruction seen in RA - Which immune cell enters the synovium of the joint?
- neutrophil
- Presence of which Ig gives a poorer px? IgG or IgM?
- IgM
- Which cytokine mediates joint destruction in RA?
- TNF alpha
- what are the two main differences b/w OA and RA?
- in OA, there is non-symmetrical involvement and the stiffness in the a.m. is mild (severe after immobility)
- What is seen in the joint space on X Ray in OA?
- osteophytes
- What is the most common cause of septic arthritis?
- bac due to hematogenous spread
- Why is there a wide range of distribution of cortisol secretion among people?
- Levels of CYP 450 differ b/w people
- Where does the gluct. R receive cortisol in the cell?
- Cytoplasm. Binding of cort causes a conformation change that brings the R into the nucleus.
- Glucts. are catabolic. They also have waht affect on glucose with respect to the liver?
- They induce gluconeogenesis
- Addison's dz is too little/too much glucts?
- too little. these pts have a hard time maintaining blood glucose levels and adapting to stress.
- what are some clinical uses of glucts?
-
skin for allergic rxns
malignancies - ACTH is used to dx primary and secondary adrenal cortical insufficiency. How?
- If adrenals respond to exogenous ACTH, then the problem does not lie within the adrenal cx itself and is therefore a secondary insufficiency
- Will exogenous administration of glucts. increase or decrease endogenous production?
-
decrease!
Therefore, don't abruptly withdraw the drug. Decrease the amnts gradually so that the HPA axis has time to kick in again. - What corticosteroid is used to tx Crohn's dz and is unique in that it's delivered straight to the terminal ileum?
- Budesonide
- high levels of corticosteroids will display peripheral mineralocorticoid activity. what sx will indicate that this is happening?
- salt retention
- Which bone tumor is more common in kids: osteosarcoma or ewings?
- Ewings in kids under 10. Above age 10, it's most likely osteosarcoma